tbuckley/cabot-search huggingface dataset:
Abstract 15476: Methadone-Related Sudden Death in the Community
Authors: Madison Seifer, Faye L Norby, Arayik S Sargsyan, Audrey Uy-Evanado, Bernadine Dizon, Ziana Bhanji, Sean Hurst, Christopher Young, Jonathan Jui, Kyndaron Reinier, Sumeet S Chugh
Journal: Circulation (2022)

Introduction: Non-toxic levels of methadone have been associated with ventricular dysrhythmias and sudden death, but current community-based data are lacking. We studied demographics and resuscitation circumstances at the time of cardiac arrest in these individuals. Methods: We prospectively ascertained all residents of Multnomah Co., OR (2002-18) and Ventura Co., CA (2015-21) who suffered out-of-hospital cardiac arrest and had toxicology reports available. We excluded individuals under age 18 or with evidence of recreational drug use or drug overdose. Methadone levels were captured on toxicology reports from the medical examiner and resuscitation variables were obtained from emergency medical services. We used logistic regression to compare demographics and resuscitation features in those with and without methadone. Results: Of the 789 subjects who met criteria, the mean (SD) age was 49 (13) years, 34% were females, and 85 (11%) had therapeutic levels of methadone (Table). After adjusting for age, females were 2.26 times more likely to have methadone on their toxicology report (1.42-3.57; p-value=0.0005). Subjects with methadone-related deaths were younger and 3.5 times more likely to suffer cardiac arrest in a home setting compared to those without methadone. Although the prevalence of night-time arrest was similar in those with and without methadone, those with methadone were more likely to have an unwitnessed event or no resuscitation attempted. When resuscitation was attempted, 97% of those with therapeutic methadone levels had a non-shockable presenting rhythm. Conclusion: Although males account for 66% of overall sudden death events, females were twice as likely to have a methadone-related sudden death compared to males. Methadone-related cardiac arrests are difficult to resuscitate. These findings highlight the need to enhance primary prevention of methadone-related sudden deaths, and a renewed investigative focus on higher risk in women.
Abstract 15666: Survival Benefit of Implantable Cardioverter Defibrillators in Patients With Catecholaminergic Polymorphic Ventricular Tachycardia
Authors: Deni Kukavica, Alessandro Trancuccio, Maira Marino, Gala Giannini, Luca Rossetti, Muhammad Mohsin, PIETRO ORANI, Alessandro Esposito, Mirella Memmi, Raffaella Bloise, Massimo Morini, Andrea Mazzanti, Silvia G Priori
Journal: Circulation (2022)

Introduction: The effectiveness of implantable cardioverter-defibrillators (ICDs) in reducing mortality in patients with Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT) is debated.Hypothesis. The ICD confers survival benefit in patients with CPVT. Methods: We included n=238 genotype-proven CPVT patients, of whom 91 (38%) had an ICD implanted. All patients were treated with beta-blocker (BB) monotherapy. Survival probability at the occurrence of a first Life-threatening Arrhythmic Event (LAE, defined as: sudden cardiac death, aborted cardiac arrest or hemodynamically non-tolerated ventricular tachycardia) was compared between ICD carriers and non-ICD carriers. In ICD carriers, the benefit-to-harm ratio (rate of appropriate shocks on LAE over rate of major complications) was investigated. Results: During 1,643 person-years of follow-up, 35/238 (15%) patients experienced a first LAE on BB monotherapy (annual LAE rate 2.1%, 95%CI: 1.5-3.0%). Of the 35 individuals who experienced an LAE, 23 patients had an ICD when the LAE occurred, and all survived after ICD shock. Of the remaining 12 patients who were not carriers of an ICD, 4/12 (33%) died suddenly, 2/12 (17%) survived but suffered anoxic brain injury, while 6/12 (50%) survived without consequences. The probability of dying at the occurrence of a first LAE was 25-fold higher (OR: 24.9, 95% CI: 1.2-513.0; p=0.037) in patients without an ICD, as compared to patients with an ICD. Major complications occurred in 17/91 (19%) patients with an ICD (2.6% per year, 95%CI: 1.5%-4.1%). Comparing the rate of major complication to the rate of appropriate ICD shocks on LAE (LAE rate 5.2% per year, 95%CI: 3.5-7.4%), the benefit-to-harm ratio was 2, favoring the benefit of ICD therapy. Conclusion: The ICD conferred a significant survival benefit in terms of arrhythmic mortality at the occurrence of the first LAE in BB monotherapy.
Abstract 15856: Relationship Between Aortic Valve Area Assessment From Transthoracic Echocardiogram and Cardiac Computed Tomographic Angiogram
Authors: Kesavan P Sankaramangalam, Samian Sulaiman, Dipesh Ludhwani, Muhammad Uqaily, Irfan Zeb
Journal: Circulation (2022)

Introduction: AVA can be estimated by either TTE or CTA however there is only limited literature assessing the concordance between these two modalities. AVA of 1.2 has been proposed as an indicator for severe AS by cardiac CTA in previous literature. Hypothesis: In our single center experience, we are hypothesizing that if use CTA AVA cut off of 1.2 cm^2, it will have high sensitivity in identifying all severe AS patients rather than using 1 cm^2 in CTA. Methods: We retrospectively studied 255 patients with severe AS who underwent both CTA and TTE at our institute from 11/2018 to 08/2021. Aortic valve area was obtained by CTA planimetry and categorized the subjects into three groups (AVA &lt; 1 cm^2; AVA 1-1.2 cm^2; AVA &gt; 1.2cm^2). Aortic valve area from TTE was calculated by continuity equation. The subjects were further categorized into patients with high gradient severe AS (mean gradient &gt;40 mmhg) and low gradient severe AS. Results: Among 116 patients with low gradient severe AS (TTE AVA &lt;1cm^2), 45 patients had CTA AVA &lt;1 cm^2 and 39 patients had CTA AVA 1-1.2 cm^2 and 32 patients had CTA AVA &gt;1.2 cm^2. And among 129 patients with high gradient severe AS (TTE AVA &lt;1cm^22), 55 patients had CTA AVA &lt;1 cm^2, 42 patients had CTA AVA 1-1.2 cm^2 and 32 patients had CTA AVA &gt;1.2 cm^2. Overall when we use CTA AVA &lt;1.2 cm^2 in low gradient severe AS cohort, we were able to identify 72% of severe AS patients and in high gradient severe AS cohort, we were able to identify 75.2% of severe AS patients. Conclusions: From our single center retrospective study, we are observing that for both high gradient and low gradient AS, there is high level of correlation between CTA and TTE when the AVA is either less than 1 cm^2 or when it is between 1-1.2 cm^2. However, for the AVA greater than 1.2 cm^2 there is lesser degree of correlation between the modalities especially in low gradient cohort. Overall, we suggest that using the cut off AVA 1.2 cm^2 by Cardiac CTA would achieve higher sensitivity for identifying the severe AS patients.
Abstract 165: 21% Or 100% Oxygen During Cardiopulmonary Resuscitation in Asphyxiated Pediatric Piglets - A Randomized Controlled Animal Study
Authors: Solomon Nyame, Po-yin Cheung, Tze Fun Lee, Megan OReilly, Georg Schmolzer
Journal: Circulation (2022)

Background: Current pediatric resuscitation guidelines recommend 100% oxygen (O 2 ) during cardiopulmonary resuscitation (CPR), however the most effective O 2 concentration for pediatric patients remains unknown. Aim: To determine if 21%O 2 during CPR with either chest compression (CC) during sustained inflation (SI) (CC+SI) or continuous chest compression with asynchronized ventilation (CCaV) will reduce time to return of spontaneous circulation (ROSC) compared to 100%O 2 in pediatric piglets with asphyxia-induced cardiac arrest. Methods: Piglets (20-23 days of age, weighing 6.2-10.2 kg) were anesthetized, intubated, instrumented, and exposed to asphyxia. Cardiac arrest was defined as mean arterial blood pressure &lt;25 mmHg with bradycardia. After cardiac arrest, piglets were randomized to CC+SI or CCaV with either 21% or 100%O 2 or sham. Heart rate, arterial blood pressure, carotid blood flow, and respiratory parameters were continuously recorded. Results: There were no differences in baseline parameters or the duration and degree of asphyxiation. Median (interquartile range) time to ROSC was 107 (90-440) and 140 (105-200) sec with CC+SI 21% and 100%O 2 and 600 (50-600) and 600 (95-600)sec with CCaV 21% and 100%O 2 (p=0.27). Overall, 6 (86%) and 6 (86%) with CC+SI 21% and 100%O 2 and 3 (43%) and 3 (43%) achieved ROSC with CCaV 21% and 100%O 2 (p=0.13). Conclusions: In pediatric piglets resuscitated with 21% oxygen compared to 100% oxygen, using either CCaV or CC+SI had similar time to ROSC and survival. CPR using CC+SI had shorter time to ROSC and higher survival compared to CCaV. Clinical studies comparing 21% with 100%O 2 during pediatric CPR are warranted.
Abstract 15543: Fibrin-Targeted Phase Shift Microbubbles Outperform Fibrin-Targeted Microbubbles for the Treatment of Microvascular Obstruction
Authors: Soheb Anwar Mohammed, Muhammad Wahab Amjad, Xucai X Chen, Maria Fernanda Acosta, Dillon Hanrahan, Evan Unger, Emmanuelle MEUILLET, John Pacella
Journal: Circulation (2022)

Introduction: Mortality from AMI has decreased in recent years; however, microvascular obstruction (MVO) occurs frequently, and is associated with rising post-AMI CHF, and has no definitive therapy. To address this urgent unmet need, we have developed an image-guided acute therapy, termed ‘sonoreperfusion’ (SRP), that resolves MVO via ultrasound-targeted microbubble cavitation (UTMC). We previously used standard-size, fibrin-targeted MBs and demonstrated enhanced reperfusion compared to standard-size, non-targeted MBs. However, phase shift microbubbles may allow greater clot penetration and perhaps more effective SRP, owing to their much smaller size Vs. standard MBs (~200 nm vs. 3 μm). Thus, we compared the SRP efficacies of fibrin-targeted phase shift microbubbles (FTPSMBs) (Microvascular Therapeutics, Inc), to standard-size fibrin-targeted microbubbles (FTMBs) for the treatment of MVO Methods: MVO of the rat hindlimb ( n=6 ) was created by injecting porcine microthrombi into the left femoral artery under contrast-enhanced ultrasound (CEUS) guidance. DEFINITY ® MBs (Lantheus Medical Imaging) were infused (2 mL/hr) through the right external jugular vein for CEUS. Following 10 min of stable MVO, a transducer was positioned vertically above the hindlimb to deliver therapeutic US pulses during concomitant administration of FTMBs/FTPSMBs (3 mL/hr). CEUS cine loops with burst replenishment were obtained at baseline (BL), 10 min post-MVO, and after each of the two SRP treatment sessions (TX1, TX2) and video intensities were analyzed (MATLAB_R2021a) Results: FTPSMBs treatment resulted in a greater increase in the blood volume (dB) and flow rate (dB/sec) than FTMB after each 10-minute treatment session (Figure 1) Conclusions: US-guided FTPSMB cavitation causes more rapid and complete reperfusion of MVO than FTMB, likely owing to their small size and more effective thrombus penetration. Studies to explore the underlying mechanisms are underway
Abstract 234: Increased Likelihood Of Survival For Patients Presenting With Non-shockable Cardiac Arrest And Treated With A Device-assisted Head-up CPR Bundle
Authors: Kerry Bachista, José Labarere, Johanna C Moore, Ryan Quinn, Brent Parquette, Lauren Emanuelson, Charles Lick, Keith G Lurie, Guillaume Debaty, Paul E Pepe
Journal: Circulation (2022)

Introduction: Despite receiving conventional (C) CPR and other standard treatments, almost all out-of-hospital cardiac arrest (OHCA) patients with non-shockable presentations will still die. As non-shockable presentations comprise nearly 80% of all OHCA cases, alternative treatment strategies are clearly indicated. Hypothesis: Compared to C-CPR controls, treatment with AHUP CPR (defined as the combination of an automated head up positioning [AHUP] device, an impedance threshold device [ITD], and manual and/or automated suction cup-based CPR), increases the probability of survival (SURV) to hospital discharge as well as neurologically favorable survival (N-SURV) for OHCA patients with (first recorded) non-shockable presentations. Methods: Prospectively collected data were obtained from a national AHUP CPR registry from 5 early adopting first responder EMS agencies that routinely initiated immediate AHUP CPR and tracked OHCA outcomes. Comparisons were made to C-CPR controls using individual patient data from high-performing prehospital systems participating in the NIH-funded Resuscitation Outcomes Consortium ROC-PRIMED and ResQTrial studies. AHUP and C-CPR patients presenting with a non-shockable rhythm were matched for the same discrete time interval from the 9-1-1 call to EMS CPR start time and propensity score for the key baseline covariables associated with outcome (e.g., age, sex, bystander-witnessed, bystander CPR) with a 1:1 ratio. Neuro-intact survival was defined as a modified Rankin Scale &lt; 3 or Cerebral Performance Category 1 or 2. Results: AHUP CPR treatment in non-shockable rhythm cases (n=380) was associated with increased unadjusted SURV rates of 7.4% vs 3.1% for C-CPR controls (1,852): Odds ratios (OR) and 95% confidence intervals [CI] = 2.46 [1.33-3.92]. After propensity matching, AHUP CPR was associated with increased SURV and N-SURV vs C-CPR controls: OR[CI] were 2.84[1.35-5.96] and 3.87[1.27-11.78], respectively. Also, the faster AHUP was initiated, the greater the benefit. Conclusions: This analysis provides strong clinical evidence of higher likelihood of survival, including favorable neurological function, for the vast majority of OHCA patients who present with a non-shockable rhythm by using AHUP CPR.
Abstract 15633: Differences in Atrial Fibrillation Symptoms Post-Ablation by Age
Authors: Brittany Taylor, Meghan Reading Turchioe
Journal: Circulation (2022)

Introduction: The prevalence of atrial fibrillation (AF) increases with age. Although catheter ablation is a recommended treatment for AF and is safe and effective in older adults, symptom outcomes post-ablation have not been well studied among older adults. The objective of this study was to investigate differences in the prevalence of symptoms post-ablation and the need for repeat ablation by age group. Methods: From electronic health records, we used International Classification of Diseases billion codes to identify all patients with an admitting diagnosis of paroxysmal AF who were treated at NewYork-Presbyterian Hospital between 2010 and 2020. We then used Current Procedural Terminology Codes to identify patients who underwent catheter ablation. We extracted age, gender, race, ethnicity, and prevalence of repeat ablations using structured queries. We extracted symptoms post-ablation from unstructured clinical notes using natural language processing. We separated patients into five age groups and evaluated associations between demographics, symptoms, repeat ablations and age group using Chi-square tests. Results: Of the 1,414 patients studied, 34.4% were female and 58.6% were white, and 4.1% were Hispanic or Latino. Significantly more female patients were age 61-80, and significantly more non-White participants were age 51-70, compared to other age groups. There was a clinically but not statistically significant difference in the prevalence of repeat ablations by age, with nearly half of those with repeat ablations being age 61-70. There were no significant differences in symptom prevalence 6 and 12 months post-ablation. Conclusion: A greater proportion of female and non-White patients undergoing ablation are older adults compared to younger or much older (&gt;80 years) patients. There were no differences in repeat post-ablation symptoms by age, suggesting older adults may experience similar symptom reduction following ablations as younger adults.
Abstract 247: Chest Tube Insertion, Needle Thoracostomy, And Pericardiocentesis During In-hospital Cardiac Arrest
Authors: Luke Andrea, MARJAN RAHMANIAN, Anthony Carlese, Ariel Shiloh, Rithvik Balakrishnan, Aron Soleiman, Michelle Gong, Ari Moskowitz
Journal: Circulation (2022)

Introduction: Some causes of cardiac arrest, e.g. cardiac tamponade or tension pneumothorax, can only be reversed by an emergent invasive procedure; identification and treatment of these causes is critical during cardiopulmonary resuscitation. The use of emergent procedural interventions has not been comprehensively studied in the setting of in-hospital cardiac arrest (IHCA). Methods: Using the American Heart Association sponsored Get With The Guidelines ® -Resuscitation registry, we examined adult patients who received an invasive procedure (chest tube insertion (CTI), needle thoracostomy (NT), and/or pericardiocentesis (PC)) during IHCA between 2001 and 2020. Groups were compared using Fisher’s exact test for categorical variables and t-test or rank-sum for continuous variables. Outcomes were compared using multivariate hierarchical modeling accounting for clustering by hospital. Results: Of the 482,972 patients with IHCA, 11,304 (2.34%) had a procedure performed (1.24% CTI, 0.46% NT, 0.63% PC). PEA was a more likely initial rhythm in those who received a procedure compared to those who had no procedure (58.2% vs 47.8%, p&lt;0.01), and VT or VF was less likely (8.8% vs 16.9%, p&lt;0.01). Peri-arrest myocardial infarction was more likely in those who received PC compared to no procedure (21.7% vs 15.0%, p&lt;0.01). Those who received CTI or NT were more likely to be on a ventilator than those with no procedure (67.9% vs 49.7%, p&lt;0.01). The mean duration of resuscitation was longer for those with CTI, NT, and PC (29.0 min, 29.0 min, and 33.6 min) than for those who had no procedure (18.6 min, p&lt;0.01). Patients who received CTI, NT, and PC had 7%, 20%, and 27% lower odds of ROSC respectively than patients who had no procedure (aOR 0.93, 95%CI 0.91 - 0.95, p&lt;0.01; aOR 0.80, 95%CI 0.78 - 0.82, p&lt;0.01; aOR 0.73, 95%CI 0.71 - 0.74, p&lt;0.01), and 5%, 10%, and 12% lower odds of survival to discharge (aOR 0.95, 95%CI 0.94 - 0.96, p&lt;0.01; aOR 0.90, 95%CI 0.89 - 0.92, p&lt;0.01; aOR 0.88, 95%CI 0.87 - 0.89, p&lt;0.01). Conclusions: We found important differences in patient characteristics and outcomes for those who received invasive procedures compared to those with no procedure. Those who received invasive procedures during IHCA had longer resuscitations but less ROSC and survival to discharge.
Abstract 182: The Incidence And Indication For Palliative Care Consultation In A Cohort Of Out Of Hospital Cardiac Arrest Patients
Authors: Lauren Becker, Shelby Shelton, Alex Presciutti, Katherine Mayer, Dan D Matlock, Sarah M Perman
Journal: Circulation (2022)

Introduction: The indications for palliative care consultation are varied and integration of palliative care is often left to physician discretion. We sought to describe the population of post-arrest patients who receive a palliative care consultation and identify common indications for the consultation. Methods: Our study is a single center retrospective chart review from the Colorado Cardiac Arrest Registry (CCAR) including 541 patients admitted to the ICU after OHCA. Data abstracted included race, sex, preferred language, age, placement of a palliative care consult and number of palliative care meetings. A chi-squared test was used to determine statistical significance with a cutoff p value &lt;0.05. Each palliative care consultation was reviewed and the indication for palliative care consultation was coded using thematic analysis. Results: Of the 541 patients in the study sample, a palliative care consult order was placed for 73 (13.5%) patients and 55 (10.2%) patients had at least one documented palliative care meeting. Code status changed after the first palliative care meeting in 4 patients. When comparing men to women, 15% of men and 11% of women received a consult. A consult was placed in 18.7% of patients identifying as Hispanic, compared to 13.9% in white patients and 12.6% in black patients. In patients whose preferred language was not English or Spanish, 28.6% received a consult compared to 13.5% of patients preferring English or Spanish. None of these differences were statistically significant. The most common themes identified as the indication for the palliative care consultation were 1.) conflict between the physician and family; 2.) low health literacy; 3.) within family discordance on goals of care and; 4.) the need for specialty social work such as assistance with hospice planning. Conclusions: Our study found a low incidence of palliative care consultation and more frequent consultation for non-English or Spanish speaking patients, with four major prevailing themes. Further study is needed to better understand and optimize the utilization of palliative care consultation in post-cardiac arrest patients.
Abstract 15837: Decreased Placental Blood Flow in Fetuses With Congenital Heart Disease is Associated With Placental Vascular Abnormalities and Impaired Fetal Growth
Authors: Rebecca Josowitz, Deborah Ho, Somya Shankar, Rebecca Linn, Zhiyun Tian, James W Gaynor, Jack Rychik
Journal: Circulation (2022)

Introduction: Studies suggest the placenta is abnormal in fetuses with congenital heart disease (CHD), possibly due to shared abnormal vascular developmental pathways. Umbilical venous volume flow (UVVF) is a validated Doppler-derived noninvasive imaging method to assess blood flow from placenta to fetus. We previously demonstrated that mid-gestational UVVF is decreased in fetuses with CHD compared to controls. We hypothesize that decreased UVVF in fetuses with CHD is associated with placental vascular abnormalities as well as impaired fetal growth. Methods: Pregnant women carrying fetuses with CHD (n=38; n=29 single ventricle (SV); n=8 TOF, n=1 d-TGA) or without (n=38) were enrolled in a prospective case-control study. UVVF and combined cardiac output (CCO) were measured during second trimester fetal echocardiograms (echo). Postnatal placentas were analyzed and assigned a placental abnormality severity score (PASS) based on the degree of lesions associated with fetal vascular malperfusion (FVM) and chronic inflammation (CI). Biometrics were collected for all newborns. T-tests or Fisher’s Exact tests were performed to assess statistical significance. Results: Gestational age (GA) at time of fetal echo was slightly greater for the CHD group (Table). All CHD fetuses as well as subgroup analysis of SV only had decreased UVVF indexed to fetal weight (UVVF/Wt) and to CCO (UVVF/CCO). Placental PASS analysis demonstrated higher grade FVM and CI lesions in fetuses with CHD. Fetuses with CHD were born earlier and had decreased birth weight z-scores compared to controls. Conclusions: Fetuses with CHD demonstrate decreased placental blood flow in utero, higher grade placental lesions associated with FVM and CI, and decreased birth weight. UVVF reflects characteristics of abnormal placental pathology and may be a useful marker of placental malperfusion in fetuses with CHD. Future study looking at association of UVVF and clinical outcomes is warranted.